Jane English, Ph.D.
(published in the Pre- and Perinatal Psychology
Journal, Vol 7 #3, April 1992, and in The International
Journal of Prenatal and Perinatal Psychology and Medicine,
Vol 6 #3, September 1994)

Introduction

Only in the past 80 to 100 years have there been appreciable
numbers of people walking on the earth without having been through
the hitherto universal human experience of labor and delivery,
the trip down the birth canal. In 1882 advances in surgical technique
made caesearean delivery a reasonably safe procedure for both
the mother and the child. Before that, most of the mothers died.
Now, a little over 100 years later, seems an appropriate time
to look at the psychological, social and spiritual aspects of
the experience of being born caesarean, especially in light of
recent research1,2 that shows the importance of the birth experience
in formation of self image and world view.

The subject of caesarean birth is of concern to all of us.
With 25% to 40% of all births in the United States now being caesarean
deliveries, we all have close contact with caesarean born people.

Groups such as the VBAC (vaginal birth after caesarean) movement
and C-sect have for several years been addressing the mother's
perspective and the question of the politics of too many caesareans.
This article addresses the other half of the issue: Given that
there is a caesarean delivery, what is it like for the child?
What are the later psychological, social and spiritual ramifications
of having been born caesarean? Is parenting a caesarean born child
different from parenting a vaginally born child?

My interest in caesarean birth emerged from my experience over
a period of years of reliving, in dreams, meditation, therapy
and body work, the patterns of my own birth which was non-labor
caesarean. After nearly twenty years of exploration, I have come
to view the emerging map of caesarean birth primarily as a tool
for personal growth and transformation, and only secondarily as
an area of scientific research or as an explanation or justification
for various patterns of awareness and behavior.

The thoughts I am sharing in this article are based on my own
experience of having been born non-labor caesarean, and on observations
of other caesareans and conversations with their parents, spouses
and siblings. Much of this is necessarily intuitive, subjective,
and anecdotal, as formal psychological studies3,4,5 of caesarean
born people are only now being done, mostly at my urging or inspired
by my book, Different Doorway: Adventures of a Caesarean Born.6

A Scientific Perspective

As part of an ongoing discussion of the place of experiential
data in scientific research, Charles Laughlin, Editor-in-Chief
of Pre and Perinatal Psychology Journal, states that, "...in
order for experiential reports to count as scientific data...they
must be done in such a way that they make clear the entire sequence
of exploration...they must stipulate what knowledge is desired,
what procedures were followed, and what were the resultant experiences.
All of this must be described in such a way that others prepared
to carry out the procedures may reenact the entire process."
(PPPJ, Vol 6, #1. p.4)

In the case of my explorations of non-labor caesarean birth,
the knowledge desired was an answer to the question, "What
would it be like to walk on Earth in a human body without going
through the usual initiatory journey down the birth canal?"
The procedure followed was to take this desire as part of my soul
intention in this lifetime and to find parents whose next child
was planned to be non-labor caesarean born and who had a doctor
who would schedule his own wedding for my due date and thus schedule
my birth two weeks early, ensuring that I would experience no
labor. The resultant experiences are described in Different Doorway
and are summarized in this paper. To replicate these explorations
a person would have to be able to form a soul intention to be
born non-labor caesarean in their next incarnation and to find
suitable parents and medical support. Obviously, I am here defining
a "person" as having identity that transcends the physical
body.

This talk of soul, incarnation and multiple lifetimes doesn't
sound very scientific, at least not by orthodox standards. But
in the context of the criteria quoted above and of David Chamberlain's
paper "Expanding the Boundaries of Memory" (PPPJ, Vol
4, #3, pp.171-189) where he concludes that memory and consciousness
transcend the body-brain, my exploration of and reports on the
experience of being born non-labor caesarean are indeed scientific.

Literature Review

Prior to Different Doorway, the literature on caesarean birth
included books on the mother's experience7,8,9, government reports10,
histories of the medical procedure11, medical books12, and occasional
references in books on psychology and behavior13. None of these
have a transpersonal perspective, and most tend to view caesarean
birth as abnormal, pathological, or unfortunate, rather than simply
appreciating it as different.

Timothy West5 comments on the studies done so far as follows:
"The only two empirical studies involving NLCB's (non-labor
caesarean born people) against a control group of NVDB's (normal
vaginal delivery born people) are Dennis McCracken (1989)4 and
Marilyn Dickie (1988)3. McCracken's study is very strong in its
literature review and theoretical foundation, but is lacking in
an effective methodology. Not only is the appropriateness of his
sample in question, but he uses what I believe is the wrong form
of testing to detect caesarean 'differences.'"

"Dickie, with a more appropriate methodology, uses a semistructured
interview where each question has one or more answers which are
hypothesized to be 'caesarean.' Although her statistical analysis
is inadequate, it does appear that she obtained a significant
difference between NLCB responses and those of NVDB. Her sample
size is somewhat small, and she admits to several areas of bias,
especially the fact that the interviewer was aware of which subjects
were caesareans and was knowledgeable about the hypothesis of
the study."

More information on the literature appears in the annotated
bibliography, complied by Timothy West and myself, at the end
of this article.

Caesarean Personality

The following summary of some of the characteristics of people
born non-labor caesarean is based on my own personal process,
on observation of and conversation with other caesarean born people
and on observations by therapists, doctors, nurses, and parents
of caesareans. These characteristics are by no means unique to
caesarean born people; they are just more pronounced. This is
a preliminary formulation of this material, and the process of
gathering more information is continuing. (See the call for information
by Timothy West at the end of this paper.)

In a non-labor caesarean birth, union with the mother is disturbed
by the anaesthesia used in the surgery, followed by the cutting
open of the mother, which is on some level experienced by the
child who is still unified physically and psychically with the
mother. The child, still very much in a state of cosmic union,
then begins to emerge into the world and experiences being unwillingly
and abruptly pulled out of the womb. Though the actual birth could
be considered complete at this point, I have found it necessary
to include the encounter with the obstetrician as part of the
birth. The struggle with the doctor who forcefully stimulates
breathing is like labor, and there may be bonding with the doctor
following this struggle. Soon this new bond is broken as the child
is taken away to the nursery, and a physical and emotional shutting
down follows. This drama may be different for recent caesareans
as some hospitals are using local anaesthesia, allowing the father
to be present, and allowing the mother to make eye contact with
the baby and even to hold and breastfeed it immediately. The last
stage of birth extends over a period of many years as the caesarean
born person transforms the patterns learned in the caesarean delivery
and learns to make a more conscious choice to give birth to his
or her self as an individual in the world.

The following chart is an overview of the non-labor caesarean
perinatal experience for a planned cesarean with general anesthesia.

A Map of the Non-Labor Cesarean Perinatal
Experience

Stage

Tone

External Procedure

Subjective Experience

Comments

0

+

Before any procedure

Primal oceanic union

Like BPM I* except for the mother's lack of commitment to
labor with the child, in planned cesareans

Even though the body is lifted up, this feels like
falling, as it is the first full experience of gravity. A shock
to the whole nervous system as the body is unfolded without the
preparatory stimulus of labor.

5b

-

Cutting the cord

Death, defeat, total loss of support, tension in belly.

6

-

Stimulation to start breathing and clear lungs

Being attacked, murderous anger, fighting own breath
coming as yet another strange, scary sensation, orgiastic experience
of energy in the body.

Close correspondence to the feelings of BPM III*. The
doctors truly do "labor" with the caesarean baby. Even
though delivery is complete before this stage, it is very much
part of the birth.

7

++

Possibly no noticeable act, except a doctor may feel
a moment of awe and wonder

Since the nourishers are strangers they could be anyone,
or everyone, thus an experience of the whole cosmos as Mother.

* "BPM" refers to "Basic Perinatal Matirx"
in the conceptual map of vaginal birth made by Stanislav Grof,
M.D., Ph.D.

Comments: on the chart

Caesarean birth has an intense all-or-nothing quality, not
like the give and take of the waves of labor

A caesarean birth is fast, taking only a few minutes rather
than hours. Yet even within this quick experience there are abrupt
swings between positive and negative feelings.

Or, looking at it more comprehensively, a caesarean is very
slow, taking years to complete the sense of being born.

The caesarean born child is very sensitive to the ambient
tone of the operating room, especially since he/she does not
have the boundary-giving experience of labor through which to
filter subsequent stimuli.

One can expect much variation among the birth experiences
of different caesarean-born people. There are different medical
techniques, different ambient tones in different operating rooms
with different personnel.

Habits, expectations, and patterns
(some of them paradoxical and contradictory) that might be learned
in non-labor caesarean birth:

The expectation that nourishment will be followed by poisoning
and attack.

Defensiveness in relation to all approach; touch sensitivity
and paradoxically a love of physical contact once the defensiveness
has passed.

Habit of opening only when exhausted or invaded.

Residual body tension patterns that are different from those
in vaginally born people, for example, neck tensions related
to the head being pulled rather than pushed in birth.

Dependence, a feeling of needing to be rescued, inability
to act on one's own, and paradoxically, an unwillingness to ask
for help.

Anger toward would-be helpers who fail to satisfy on a physical
level the impossible demand of total rescue.

Distortion of relationship and sexual patterns with people
of the same sex as the obstetrician. Expectations of struggle
and defeat, and of merging, bonding, and being totally cared
for.

Perception of self as separate, and paradoxically, less sense
of personal boundaries.

Easy access to transpersonal awareness but lack of appreciation
of this capability because of having less sense of personal boundaries.

Continual testing of limits and boundaries.

Relationship patterns that are colorful, abrupt, intense,
and arrow-like rather than like the waves of contraction and
expansion that would be learned in labor.

Little sense of process, expectation that a relationship
either exists and doesn't need to be nourished, or doesn't exist
and is impossible.

Being not particularly goal oriented and feeling criticized
for this; wanting to have goals but feeling unable to find any
that seem real.

Strong negative self-judgement for not meeting others' unconscious
expectations that one know the relationship patterns and sense
of limit usually learned in vaginal birth.

Trust that help will always be there without one having to
ask for it.

Another way of conceptualizing the differences between being
born caesarean and being born vaginally is the different concepts
of space and time each kind of birth teaches. A non-labor caesarean
birth takes about two minutes; the way things change is totally,
suddenly and abruptly and all at once. You're here, then suddenly
you're there. Something external got you from here to there. It's
not something that emerged organically from within your own process.
The lesson is that in order to get from here to there you look
outside yourself and find something that will move you. There's
a great ambivalence about that because this help is an invasion,
intrusion and interruption which you resist.

By comparison, in vaginal birth the lesson is that there's
a slow process, false contractions before, lots of warning, lots
of sense that something is changing. In labor you learn that you
do a little bit, then you get to rest.

This caesarean sense of timing may show up later in life as
an all-or-nothing quality in relationships and interactions. The
dependence on external help can take the negative form of feeling
angry, helpless and victimized. It can also take the positive
form of being able to mobilize a team of helpers in any situation,
feeling confident that help is always available.

Non-labor caesareans do not experience the high pressure squeezing
of contractions and the journey down the birth canal, and thus
have a different learning about space. Caesareans may not have
a strong sense of boundaries and limits, of their place in the
world. In vaginal birth you're diminished, you're limited, you
learn that you are not the whole universe, you're not the infinite
expansive spirit. You're put in your place. Many caesarean people
get "put in their place" later on in life by people
who expect them to have this inborn sense of limits, which they
don't have because it wasn't part of their birth learning. So
over and over they are put in their place, told to not be so intrusive,
often told with a lot of negative judgement.

However, there is a positive side to being put in your place.
It is being given your position, being given a ground to work
from, a limited place from which to go forth. You have a sense
of belonging, of how you fit in to something larger. You can only
fit into something larger if you have a sense of limitation. Limitation
is not all bad. Many of the mothers and fathers, friends, siblings,
and other people who interact with a non-labor caesarean born
person are literally giving birth to them. They are laboring with
them, are giving them limits and boundaries, are putting them
in their place. If this can be done with conscious intention without
judgements like, "You're wrong, you're bad, you're exceeding
limits that you should already know," and done simply as
an offer of limits and boundaries as gifts, it gives security.
It gives a sense of "This is what is appropriate given that
I am in a limited human body." In life it's often good to
be pushing the limits, but it's also good to know that there are
limits, that one doesn't have to do everything. When one accepts
limitation one can appreciate other limited human beings and know
that together we make up the whole.

There is also a positive side to the caesarean sense of limitlessness
and lack of boundaries. There is an easy knowing of the reality
of spirit, an unquestioned sense of living in the context of an
all-pervasive perfection. This is often not appreciated by caesarean
born people until they have become more clear about limits and
boundaries and can see the vastness they have as a native gift.

None of these ideas about the caesarean born person's sense
of time, space, relationship and limits should be taken as absolutes.
They are simply general tendencies, concepts that may be helpful
in a relationship between a vaginally born person and a caesarean,
or for facilitating a caesarean born person's self-understanding
and self-acceptance. A person born in a caesarean delivery after
some labor will share characteristics with both the vaginally
born and the non-labor caesarean born.

When a vaginally born person and a caesarean born person relate
in more than superficial ways, they cannot help but challenge
each others deeply held, and often unconscious, sense of reality
and identity. It is as if they each came from different native
cultures ("native" in the literal sense of having to
do with birth!). In this situation a non-judgmental appreciation
of differences is an important attitude to hold. When one is in
conflict with a person of a different birth learning it is important
to take a "looks within" moment to see which of one's
own birth-based beliefs about reality is being challenged. This
is especially important in the intensity of parenting a child
who was born in a different way than oneself.

Caesarean Birth and Psychotherapy

Knowledge of this material will be helpful in psychotherapy
with caesarean born people. Not all of the caesarean personality
traits should be regarded as problems to be resolved; many are
actually gifts to be affirmed. Therapy can be a process of sorting
these out and acknowledging the somewhat different native culture(native
in the literal sense of "natal", having to do with birth)
of the caesarean born person.

When a therapist of the same sex as the obstetrician works
with a caesarean born client, much of the dependence, desperation,
fear, and anger the caesarean born person feels about helpers
are projected onto the therapist, especially when the therapy
focuses on breathing. Knowledge of the origins of these feelings
can help the therapist neither take them personally nor judge
them negatively. Caesareans dealing with the rescue/dependence
issues need a therapist who trusts them to stay alive on their
own no matter how bizarre and precarious the mental, emotional,
and physical situation seems. With the non-labor caesarean born
person's less well defined boundaries, the therapist needs also
to be aware that the person may not have a clear sense of what
staying internalized in their own process means, and the therapist
may need to help them find the balance between rigid shutting
down and unconsciously identifying with everything around. The
caesarean born person needs people who will "labor"
with him or her and not expect knowledge of vaginal birth-learning.
In labor the mother and child go through an intense, potentially
life-threatening process in which they establish themselves as
physically separate individuals. They enter into this not knowing
how it will happen but trusting that it will happen. A non-labor
caesarean born person looks for this kind of deep pre-verbal,
bodily commitment in post-delivery relationships. A therapist
may easily confuse this necessity for labor with manipulation
and demand for attention by the caesarean born person.

In the process of transforming caesarean birth-learning, there
is a need for awareness of transpersonal levels of reality in
both the therapist and client. This is especially important in
relation to the pattern of dependence, of intense attachment to
a helper or rescuer. Chinese folk wisdom says that a baby that
falls off a boat should not be rescued because it will become
totally dependent on its rescuer. For me, this story was a challenge
as I sought to reconcile a deep sense of dependence with a desire
to be responsible for my life. Eventually I came to know that
the "seed of truth" at the core of the dependence was
an experience of union, of mergence. In the context of the caesarean
birth experience, the way out of dependence and defeat is to know
the union of the doctor, mother and child, to identify with all
three at once. The release of the dependent behavior patterns
comes not through effortful independence but through full awareness
of inner or transpersonal connectedness in the light of which
physical separation is trivial or playful. Experience of true
individuality has to be preceded by a surrender or death of apparent
independence or separateness. The fears associated with separateness,
dependence, and defeat form a barrier of pain that has to be experienced
on the way to awareness of union, to experience of the archetypal
Cosmic Mother, the One Heart-Mind.

In working with the apparent dependence the therapist needs
to be adept at establishing and maintaining inner connection with
the caesarean born person, a connection the person can experience
being sustained through physical separation. This inner connection
forms an intermediate step toward experience of connectedness
at the archetypal level, at which point the therapist is no longer
needed14.

A person born non-labor caesarean experiences a somewhat different
way of being in the world and has some different illusions to
transcend on the way to integrating personal and transpersonal
realms of experience. Birth can be seen as a gateway between the
personal and transpersonal realms. The "demons" that
guard this gateway in the experience of a caesarean person are
different from those of a vaginally born person. A comparison,
an appreciation of differences, is useful to both in perceiving
their own "demons" more clearly. A map of the experience
of caesarean birth, a "Field Guide to the Demons" is
a useful tool, a temporary scaffolding to stand on in the process
of transformation in psychotherapy. And as with any scaffolding,
it should be removed after the transformation is complete.

Differences As Opportunity

Situations where a vaginally born person is in a close relationship
with a caesarean born person, be it parent and child, therapist
and client or a marriage, are actually opportunities for both
people to transcend their particular birth learning and meet at
a deeper level of shared humanness. However, there is need for
a high level of commitment and good will from both because each
will challenge the other's deeply held beliefs and self-images.
Each can also offer the other new and useful patterns of behavior
and consciousness. For example, a caesarean born person can learn
the wavelike give-and-take relationship pattern that a vaginally
born person learns in birth, and a vaginally born person can learn
the arrow-like directness a caesarean born person learns in the
caesarean delivery.

When both the vaginal birth pattern of aggressive action, of
pushing through, and the caesarean birth pattern of helpless inaction,
of inability to push through, are known as options rather than
absolutes, one may experience a new kind of effortless action
that is akin to the Chinese "wei wu-wei", action that
doesn't create an experience of subject "in here" acting
on object "out there."

Conclusion

It is important not to judge one kind of birth as being better,
at a really deep level, than any other kind of birth. Each birth
teaches different things. A soul may incarnate with specific intentions
that are matched beautifully by a caesarean birth that to someone
else may seem violent and abrupt. But it may be exactly what the
soul needs in order to learn lessons for which they are choosing
to come on earth. Yet this is full of paradox; it depends what
level one is talking about. While at the level of soul intention
there is no such thing as an imperfect birth, at the level of
personality, of everyday life, the humanizing of birth is very
important. We need to make birth part of the process of human
life rather than an isolated medical event, to make it as full
of love and as gentle and connected as possible, to make caesarean
birth the welcoming of a new human being rather than just a surgical
process. In watching a caesarean birth, there is an astounding
moment of seeing a little face come up out of the blood, and knowing
that this is another soul incarnating here on the earth and this
is how she or he is coming in.

For a variety of reasons many probably unnecessary caesarean
births are being done, but we need to set that issue aside for
a moment, and understand what the child experiences. We need to
be able to not categorize caesarean birth as pathological. It
is simply birth. We need to ask, "How can we do them better?"
For instance, there is often soft music in family centered birthing
rooms, so why not have music in the operating room? It would probably
make everybody happier, including the baby.

Vaginal birth has been around as long as humans have; there
has been time for folk wisdom about birth to evolve. Caesarean
birth is a recent development and needs its own folk wisdom. Share
this article with your friends, talk with other caesarean born
people and caesarean mothers. I have only one perspective on caesarean
birth; all of you also have something to contribute. I encourage
you to do so.

Annotated Bibliography

(compiled jointly by Jane English and Timothy West)

1) Feher, Leslie, The Psychology of Birth, New York, Continuum,
1980.
Good descriptions of personality traits associated with different
kinds of birth. Interpretations are limited by its author's Freudian,
mechanistic conceptual framework. This is a basic resource, one
of the first to look at the psychological effects of different
birth processes in a systematic way. A mainstream, accepted text
in the field and, as such, a good resource around which to build
further research.

2) Grof, Stanislav, Realms of the Human Unconscious, New York,
Dutton, 1976.
A pioneering work that maps the progressively deeper layers of
the psyche: personal history, perinatal experience and the transpersonal.
Includes a detailed map of the relations between a person's vaginal
birth experience and their later personality traits. A basic text
in the field of perinatal psychology and its implications for
subsequent development.

3) Dickie, Marilyn, Caesarean Births: Different Doorways to
Life, (Master's Thesis), Smith College School for Social Work,
Northampton, MA, 1988
Important research. Dickie follows three main caesarean trends
from the anecdotal literature: lack of interpersonal boundaries,
difficulties making plans, and dependency. She found that in all
three of these areas non-labor caesareans had statistically significant
deviations from a vaginally born sample in their responses to
a questionnaire. She includes numerous suggestions about how to
improve on her methodology which can be of help to future researchers
in th field.

4) McCracken, Dennis, Caesarean Personality Traits, (Doctoral
Dissertation), The Professional School of Psychology, San Francisco,CA
1989
A recent piece of research which did not find correlations between
certain personality constructs and non-labor caesarean birth.
Includes a good discussion on the confounding variables which
may be involved with survey based research on caesarean birth.
A fine collection of background material an rationale for hypotheses
concerning the caesarean born. This study is invaluable in determining
what psychological tests will detect the caesarean "difference."
Results imply that caesareans may compensate to hide their differences
in a vaginally born culture.

5) West, Timothy, private communication (Doctoral dissertation
research proposal, California Institute of Integral Studies, San
Francisco, CA 1992)
Research in progress on the existence of "caesarean differences."
Considers the possibly destructive attempts to fit caesarean functioning
and world-view into the structure of majority(vaginal) culture,
in the research methods themselves as well as in society in general.

6) English, Jane, Different Doorway: Adventures of a Caesarean
Born, Mount Shasta, CA, Earth Heart,1985
A thorough and vivid anecdotal account of a caesarean born woman's
journey of self-discovery. The work includes memories, dreams,
and a chronological account of a ten year psychotherapeutic process
which directly addresses her experience of being born non-labor
caesarean. The last section contains informative interviews conducted
by the author with other caesarean born individuals. An excellent
source of subjective accounts of caesarean birth's psychological
effects over the life cycle. Transpersonal values are kept in
the foreground throughout the book.

7) Donovan, Bonnie, The Cesarian Birth Experience, Boston,
Beacon Press, 1977
This book covers the caesarean experience from the medical recovery
aspect rather than its psychological or transpersonal aspects.
It is a basic, mainstream perspective on caesarean birth

9) Mutryn, Cynthia, Psychosocial Impact of Caesarean Section
on Families: A Literature Review(technical paper), presented at
the Fourth International Congress on Pre and Perinatal Psychology,
Aug. 3-6, 1989
An overview of research findings concerning attitudes of families
toward their caesarean born children, with focus on the mothers.

10) Marieskind, Helen, An Evaluation of Cesarean Section in
the United States,, Dept of HEW, 1979
A goldmine of statistics on caesarean birth.

11) Pundel, J.P,L'Histoire de L'Operation Cesarienne,
Brussels,Presses Academiques Europiennes 1969
An excellent comprehensive history of caesarean birth. Many illustrations,
good sections on mythology and legend. In French but worth looking
at just for the illustrations.

12) Affonso, Dyanne, The Impact of Caesarean Birth,
Philadelphia, F.A.Davis, 1981
This book is written for medical professionals, but is easily
read by others. Covers in detail the medical techniques of caesarean
birth and also some of the psychology of the mother's experience.
An excellent background source covering the caesarean operation
and its medical implications.